Thank you for sharing your thoughtful and reflective feedback regarding the manuscript, “Creating Workplace Environments that Support Moral Courage,” co-authored by myself and Dr. Bjarnason that was published in the September 30, 2010 issue of OJIN:The Online Journal of Issues in Nursing.

The issue of inadequate staffing that you articulated as a significant source of moral distress for nurses practicing in a variety of settings cannot be denied. However, the focus of our manuscript was to inspire and inform nurses as to how they can incorporate moral courage into their practice as an empowering tool to advocate for their patients, their practice, and the improvement of the overall quality of their respective workplaces.

As someone who is passionate about clinical ethics and ethical dilemmas in nursing, I respect, but beg to differ with your comment concerning nurses’ lack of fear regarding these ethical/moral dilemmas of which there are many, or the fear of reprisal or worse in advocating for what is right. As a member of the Ethics Advisory Board within the American Nurses Association Center for Ethics and Human Rights, I can assure you that the Center receives many inquiries from nurses who have been threatened with termination, brought to litigation, or actually terminated from their jobs because they chose to act with moral courage by upholding professional practice standards and doing the right thing. The question is will we adopt a victim mentality thus allowing ourselves to become disempowered by conditions around us, or will we adopt the posture of embracing moral accountability and responsibility for our practice in defending the rights of our patients and ourselves to create workplace environments the engender the values and the ethic of care that have been germane to nursing, as embodied by Nightingale and the many who have followed her?

I also disagree with your assertion that prohibitive healthcare costs are, in and of themselves, a source of disempowerment for nurses serving as catalysts for change. I contend that we as a profession have failed in our ability to educate nurses to articulate clearly who we are, what we stand for, and how we can creatively and effectively unite to promote the changes necessary to create positive, productive workplace environments where nurses are truly appreciated and recognized, as former President Clinton noted, as “the heart and soul of healthcare.” Everything begins and ends at the bedside. I also think we have not empowered nurses to internalize the view that every nurse is a leader regardless of position. It is important that nurses in formal leadership positions foster this belief among their nurses through education, role modeling, and mentoring.

Nursing has withstood many a nursing shortage and has always responded with resiliency and resolve. As someone in her 39th year of practice, I have no doubt that nurses will continue to do so. However, nurses need to find ways to translate that which is negative into the positive. Nurses who possess moral courage do this despite the obstacles. Healthcare organizations that create environments in which nurses are at the table advocating for the rights of patients, families, and colleagues will flourish, but it is up to us to assure that this happens.

Again, thank you for the time you took to submit such a thoughtful response. I wish you all the best as you continue to advance in your career.